Tuesday, March 22, 2011

An “Ah-Ha” Moment for the Oncology Community

This is my third attempt at writing this complex blog entry. The first two attempts were too cumbersome and convoluted; they did however help me crystallize my viewpoint.

Here’s the hypothesis…

Given relatively recent advances in genetic testing, the human genome project, the cancer genome project, and human cell molecular modeling, individual results from clinical cancer trials are being sorely underutilized.

Personally, I’m closest to head and neck cancer as I follow news stories on it daily. However, my hypothesis applies to all clinical cancer trials. I will use a head and neck clinical cancer trial as an example in support of this hypothesis.

There are a set of head and neck oncologists who believe that patients with recurrent head and neck squamous cell carcinoma who do not respond to platinum-based chemotherapy have run out of treatment options and in turn have a very poor prognosis. See link in Reference #1 at the bottom of this blog entry. The article is about a paper presented at the 2010 ASCO (American Society of Clinical Oncologists) meeting and it backs up this assertion of a poor patient prognosis.

There have been early phase clinical head and neck cancer trials which on the surface have shown promising, but inconclusive results. See link in Reference #2 at the bottom of this blog entry to clinical trial NCT00442507 at www.clinicaltrials.gov. This was a phase II trial using a combination of Tarceva and Avastin that included 48 patients beginning in March 2007 and ending in January 2009. The results of that trial were printed in an article on www.cancerconnect.com (see Reference #3). On the surface the results of the clinical trial are positive, but lukewarm… Article headline, “Combination of Avastin® and Tarceva® Shows Promise in Head and Neck Cancer.” If you read the article it goes on to say, “Seven patients experienced a complete or partial disappearance of detectable cancer.”

Here’s the quandary. A group of oncologists at last year’s preeminent oncology event, ASCO, reported that the prognosis for recurrent head and neck cancer patients who failed platinum-based chemotherapy was poor. Yet, we have a study which completed in January 2009 where seven patients which fit the profile of this poor prognosis group experienced a complete or partial disappearance of detectable cancer. To my eyes, this is a major disconnect in viewpoints.

If, and this is a big “if,” one was able to use recently developed genetic testing to have pre-picked just those seven patients for this trial, the article headline would have read, “HEAD & NECK CANCER CURED IN SOME PATIENTS,” it would not be “Shows Promising Results.”

If I were part of the oncology community, this would be an “Ah-Ha” moment for me. What can we learn from those seven patients that will allow us to effectively use these targeted chemotherapies to save lives efficiently? I don’t know if the oncologists running this clinical trial have thought about exploring this path of reasoning. If my hypothesis is correct, they haven’t. In this example, I hope I'm wrong.

To test this hypothesis, I’m going to try and contact the oncologists for this clinical trial to understand where the results from this trial have led. Please remember, this is just one example. In a more strategic sense, what can we learn from all the other individual successes in all the other clinical cancer trials that have been recently completed or are in progress? My hypothesis says that the individual successes are being underutilized. More on this story as further facts are known.

Take care everyone.

Ref #1 – 2010 ASCO Presentation article

Ref #2 – Clinical Trial

Ref #3 – Clinical Trial results article

Post Script
I struggled with this blog entry. Another appropriate title would be, "Reverse engineering a cure for cancer."

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